Waist circumference as a predictor of cardiovascular risk

Body Mass Index, or BMI, has been used since the 1980s to estimate risk for a variety of obesity-related diseases. Waist Circumference (WC) is also strongly linked to obesity-associated risks. WC has been proposed as a simpler measurement than BMI that also more accurately reflects body fat distribution. In a study of white men and women published in the American Journal of Clinical Nutrition, Zhu et al. correlated 4 well-known obesity risk factors for cardiovascular disease (CVD) with both WC and BMI. The subjects' known CVD risk factors were more closely related to their WCs than their BMIs. The authors suggested specific WC "cutoff limits" indicative of the need for intervention to prevent increased CVD risk.

The 9019 study participants were provided from the National Health and Nutrition Examination, which assessed the non-institutionalized US population from 1988 to 1994. They included 4388 men with an average age of 44 years and 4631 women with an average age 47 years. Their average BMI was 26, within the overweight category. The average WC was 96.4 cm for the men and 88.2 cm for the women. Each subject was assessed for the presence of 4 CVD risk factors: low HDL (high-density lipoprotein) cholesterol; high LDL (low-density lipoprotein) cholesterol; high blood pressure, and high glucose. Overall, 48.5% of the men and 50.2% of the women had 1 or more of the CVD risk factors.

WC was found to correlate better than BMI with the majority of the risk factors examined. The authors identified WC "cutoffs" of 90 cm (35 inches) for men and 83 cm (33 inches) for women as the point at which patients should be advised to avoid future weight gain to minimize CVD risk.

An associated editorial by Lean and Han considers certain practical problems involved in the measurement of WC in a clinical setting. In the future, similar studies should be directed at developing the same type of WC-disease risk correlations for other races and for chronic dise

Contact: Elizabeth Horowitz
American Journal of Clinical Nutrition

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